The present invention relates generally to intestinal catheters and more particularly to a catheter for insertion into the small intestine via the upper gastrointestinal tract.
The gastrointestinal tract comprises, in descending order from the mouth or nose, the esophagus, the stomach, the small intestine and the large intestine. The small intestine or bowel comprises, in descending order, the duodenum, connected to the stomach through an opening called the pylorus, the jejunum, which connects with the duodenum at a location identified by an adjacent ligament called the ligament of Treitz, and the ileum which in turn connects with the large bowel or colon. The duodenum includes two portions, a first portion wich is accessible to a surgeon when the abdomen has been opened incident to the performance of surgery on the small intestine, and a second portion, called the retroperitoneal portion, which is inaccessible to a surgeon when the abdomen has been opened incident to surgery on the small intestine.
Certain patients suffer from an obstruction in the small intestine. This obstruction is caused by scar tissue on the outside of the small intestine which constricts or squeezes the bowel causing the bowl upstream of the obstruction to become massively dilated, i.e., swollen or puffed up, while the bowel downstream of the obstruction remains normal sized. The scar tissue which causes the obstruction usually occurs following abdominal surgery, but it can occur from inflammation of the bowel. When the obstruction occurs following abdominal surgery, it may occur within any time from a few days to several years after the surgery. Although some patients having such an obstruction can be treated without surgery to alleviate the problem, many such patients require surgery in order to alleviate the problem. In such a case, the obstruction is removed by a surgical procedure in which the abdomen is opened and the scar tissue is cut away, thereby allowing the bowel on both sides of the obstruction to eventually equalize.
Incident to such surgery, it is desirable to aspirate or suck out the contents of the small bowel upstream of the obstruction. Heretofore, this has been accomplished by cutting an opening in the jejunum (a jejunostomy) upstream of the obstruction, inserting a catheter or intestinal tube into the jejunum through the opening cut therein, and aspirating the contents of the jejunum and ileum as the catheter was moved downstream through the bowel towards the obstruction. The contents of the bowel were aspirated upstream through the tube into the proximate or upstream end of the tube, located outside the jejunum and connected to an aspirator or source of suction.
It is not possible to push the tube through the length of the small intestine from the insertion hole to the obstruction. Rather, the tube must be pulled through the intestine by manual manipulation through the walls of the intestine. Because the tube normally has a relatively small diameter, compared to the diameter of the jejunum, and because the tube becomes slippery once it is inserted into the jejunum, the tube cannot be grasped through the walls of the bowel, and grasping the tube through the walls of the bowel is necessary if the tube is to be pulled through the bowel.
In prior art intestinal tubes this problem was solved by providing an inflatable balloon at the distal or downstream end of the tube. Once the tube was inserted into the jejunum, the balloon was inflated from the upstream end of the tube, and this caused a bulge in the walls of the jejunum which the doctor could grasp and then manipulate with his fingers to work the balloon downstream along the length of the small intestine until it reached the obstruction.
At the conclusion of the surgery, the tube was worked further downstream through the small bowel and then, with the tube in place throughout the entire length of the small bowel, the tube acted as a guide for plicating the small intestine into place within the abdomen. In other words, the tube allowed the small bowel to be readily placed into an arrangement of orderly folds or convolutions, within the abdomen, without the occurrence of kinking in the small bowel as it was arranged in the convoluted disposition. The prevention of kinking is important. Otherwise, a new obstruction could occur wherever a kink is located. The inherent rigidity of the tube within the small bowel prevented the bowel from kinking.
When the abdomen was closed following surgery, the proximate or upstream end of the catheter tube was run to the outside of the body, through an opening in the skin, using a conventional surgical technique, and the tube was allowed to remain in the jejunum for a number of days after the surgery to assure that the small bowel remained in the desired, unkinked disposition with regular folds or convolutions. During this postoperative period (e.g., 8-10 days), the contents of the small intestine could be drained through the tube. Thereafter, the tube could be removed through the opening in the skin using conventional techniques.
It has been found, however, that problems occurred when the tube was inserted into the jejunum through an opening cut into the jejunum for that purpose and when the proximate end of the tube was brought to the outside of the body through an opening cut in the skin of the patient for that purpose. These problems included an increase in the wound infection rate among patients, compared to the wound infection rate of patients where this procedure was avoided. Additional complications arising from this procedure included recurrent obstruction at the site where the jejunum was cut, persistent pain at the jejunostomy site, bursting open of the wound and other complications. Many patients suffering from these complications required re-operation.